Single Dose Of Dexamethasone Research Articles

Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions.

Pemetrexed (Alimta®) is a novel anti-folate antimetabolite agent that is used in combination with cisplatin for the treatment of patients with unresectable malignant pleural mesothelioma and as a single agent or in combination with cisplatin for patients with locally advanced or metastatic non-small-cell-lung-cancer. Cutaneous adverse reactions are common side effects of pemetrexed for which the manufacturer recommends 3-day premedication with dexamethasone 4 mg by mouth twice daily-(the day before, the day of, and the day after treatment). Patients' adherence to this premedication regimen is of concern. We report 14 cases of metastatic non-small-cell-lung-cancer patients who were premedicated with a single dose of dexamethasone 20 mg prior to pemetrexed or pemetrexed-based chemotherapy. None of these patients reported a grade 3 or above skin reactions over the course of their treatments. These findings suggest that a single dose of dexamethasone 20 mg may be an alternative premedication regimen in patients with metastatic non small cell lung cancer receiving pemetrexed or pemetrexed-based chemotherapy.

A survey of antiemetic dexamethasone administration-frequency of use and perceptions of benefits and risks.

Postoperative nausea and vomiting (PONV) is a significant concern for anaesthetists. There are many agents from different classes that are effective in both preventing and treating PONV. Dexamethasone is a very effective antiemetic, but there are concerns regarding its safety. We performed an anonymous survey of a random selection of the fellows of the Australian and New Zealand College of Anaesthetists to ascertain patterns of practice in relation to PONV prophylaxis and treatment and also to determine awareness of the risks and benefits of perioperative dexamethasone administration. The response rate was 33%. From the responses, 71.2% of all patients undergoing general anaesthesia in the respondents' institutions receive PONV prophylaxis in total and 46.6% receive dexamethasone. No respondent gives more than a single dose of dexamethasone and there was an almost equal split between those who administer 4 and 8 mg, with a smaller number dosing on a weight basis. 5HT-3 receptor antagonists and dexamethasone are the preferred first-line PONV prophylactic agents and 5HT-3 receptor antagonists and droperidol are the preferred first-line PONV therapeutic agents. Concerns relating to the safety of dexamethasone were expressed by 80% of respondents. From this survey, we concluded that the PONV practice of the respondents is largely compliant with recent consensus guidelines, although PONV prophylaxis appears to be given more routinely. It also appears that more education is required on issues regarding dexamethasone safety.

Single Dose of Dexamethasone with or without Ibuprofen Effects on Post-Operative Sequelae of Lower Third Molar Surgical Extraction

Single Dose of Dexamethasone with or without Ibuprofen Effects on Post-Operative Sequelae of Lower Third Molar Surgical Extraction

Combined Fluorescence and Magnetic Resonance Imaging of Primary Macrophage Migration to Sites of Acute Inflammation Using Near-Infrared Fluorescent Magnetic Nanoparticles

This study aimed to track the migration of primary macrophages labeled with near-infrared (NIR) fluorescent magnetic nanoparticles toward chemically induced acute inflammatory lesions in mice and to visualize the effect of anti-inflammatory drugs on macrophage migration using combined fluorescence and magnetic resonance imaging (FLI/MRI). Primary macrophages were labeled with NIR fluorescent magnetic nanoparticles, and labeled cells were injected into mice intravenously. One day later, inflammation was induced by subcutaneous injection of 1% carrageenan (CG) solution to footpads of the right hind leg, and phosphate-buffered saline (PBS) as control treatment was subcutaneously injected to footpad of the left hind leg. To evaluate the effect of drug treatment on macrophage migration, a single dose of dexamethasone (DEX) was intraperitoneally administered to the mice immediately after the induction of inflammation and was followed by combined FLI/MRI at predetermined time points. No difference in cellular viability or phagocytic activity was observed between the labeled and parent macrophages. In vivo optical imaging revealed an increase in FLI signals in CG-injected footpads in a time-dependent manner, but not in PBS-treated footpads. DEX treatment inhibited the migration of the labeled macrophages to the CG-injected footpads, with relative decreases in FLI activity. In accordance with FLI, T2*-weighted MR images showed hypo-intense signals in the CG-injected footpads but not in the PBS-injected footpads. The DEX-treated mice did not show a dark signal loss zone on MR images in the CG-treated paw. We successfully tracked the migration of macrophages to inflammatory lesions using both FLI and MRI with NIR fluorescent magnetic nanoparticles and demonstrated the inhibitory effects of DEX on macrophage migration to inflammation sites.

An Audit of the Use of Olanzapine as an Anti-emetic, in Combination with Ondansetron, Domperidone and Single Dose Dexamethasone, in Patients Undergoing BEP Chemotherapy (Cisplatin, Etoposide and Bleomycin) in Germ Cell Tumours

An Audit of the Use of Olanzapine as an Anti-emetic, in Combination with Ondansetron, Domperidone and Single Dose Dexamethasone, in Patients Undergoing BEP Chemotherapy (Cisplatin, Etoposide and Bleomycin) in Germ Cell Tumours

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Atrial fibrillation (AF) occurs frequently after cardiac surgery and is mostly self-limiting. It relates to direct surgical effects on the atria, atrial ischaemia during surgery, adrenergic activation and a general state of inflammation. Although most postoperative AF is transient, it may lead to a prolonged hospital stay and increased mortality [1]. Treatment strategies include the use of beta blockers, several antiarrhythmic drugs such as propafenone, sotalol and amiodarone, antioxidants to reduce ischaemia-reperfusion damage, angiotensin inhibition and anti-inflammatory medication such as N-acetylcysteine, naproxen, colchicine and glucocorticosteroids. In this edition of the Netherlands Heart Journal, Jacob et al. [2] report a substudy of the DECS study [3], which aims to describe the influence of a single high-dose infusion of the glucocorticoid dexamethasone during cardiac surgery on the perioperative function of the left atrium and the development of postoperative AF. The authors have put much effort into the sophisticated analysis of transoesophageal echocardiography recordings (TEE). We commend the investigators for their focus on atrial function rather than atrial size only, especially since atrial function may better reflect atrial pathophysiology than merely looking at atrial anatomy. Their methodology should be followed when evaluating atrial performance in order to understand atrial remodelling processes much more efficiently. In the original DECS study [3], dexamethasone did not reduce the incidence of postoperative AF, suggesting that a single dose of dexamethasone cannot effectively ameliorate atrial inflammation, which is one of the presumed arrhythmogenic mechanisms. In line with that previous observation in the main DECS study, the present substudy shows that dexamethasone is not associated with preservation of atrial function at the very end of the operation. We again commend the investigators for having performed such extensive TEE analyses. We understand that collecting data immediately after surgery was most appropriate considering the complex logistics and limited acceptance of TEE in the awake patient. On the other hand, atrial inflammation may not be at its peak right after surgery and therefore the investigators may have missed the beneficial effects of dexamethasone on atrial function. This notion is fed by the fact that postoperative AF reaches its highest incidence on day two after cardiac surgery [4]. Comparing preoperative and postoperative left atrial (LA) function within the dexamethasone and placebo groups (rather than the presented comparison between dexamethasone and placebo before and after surgery) suggests that the LA total emptying fraction is stable in the placebo group, while it seems to decrease in the dexamethasone group. Whilst correction of the LA function parameters for fluid status may appear explanatory one cannot exclude an early unexpected deleterious effect of dexamethasone potentially precluding a net positive effect during the next few days after surgery. Future studies on postoperative atrial inflammation may shed more light on these notions. The present study shows the feasibility of assessing perioperative atrial function using TEE. However, it also illustrates the limitations of fitting methodology to standard care which precluded observing atrial inflammation when it—expectedly—was at its peak. To paraphrase the present Dean and Vice Chairman of the Board of the University Medical Centre Utrecht, it is time for a ‘transition in science’ [5]. Among others, this may be taken by clinical scientists as a call for always creating the most optimal methodologies whilst respecting clinical routines. This certainly will contribute to producing high-quality papers with impact, which can be used to guide important clinical decisions and thus improve the quality and length of patients’ lives [5].

The effect of intraoperative administration of dexamethasone for PONV prophylaxis on perioperative blood glucose level in obese and normal weight children.

The incidence of postoperative nausea and vomiting (PONV) can be reduced by dexamethasone. Single-dose administration may cause elevated blood glucose levels in obese adults. No data are available for children. The aim was to evaluate perioperative blood glucose changes related to body weight in children who received dexamethasone. This prospective observational study included 62 children. All patients received total intravenous anesthesia and a single dose of dexamethasone (0.15 mg/kg, maximum 8 mg). Blood glucose levels were measured up to 6 h. Standard deviation scores (SDS) were calculated using age- and gender-specific body mass index (BMI) percentiles, p<0.05. A total of 62 children (11.5±2.9 years, median SDS 0.43, 29% overweight/obese) were included. Blood glucose levels increased from 5.52±0.52 to 6.74±0.84 mmol/L 6 h after dexamethasone without correlation to the BMI-SDS. This study showed an increase of perioperative blood glucose (normoglycemic ranges) after single dose of dexamethasone, but no BMI-dependent effect was observed in children. Therefore, low-dose dexamethasone may be used in obese children for PONV prophylaxis.

The preoperative single dose dexamethasone effect to pro-and anti-inflammatory cytokine during orthopedic surgery

Background: The efficacy of glucocorticoids like dexamethasone in reducing postoperative pain has been investigated and showed that a single dose of dexamethasone significantly analgesia has advantages in terms of reduction in pain intensity, opioid requirements, rescue analgesia, and did not increase the incidence of infection and impaired wound healing. The aim of this study was to evaluate the effects of preoperative single dose of intravenous dexamethasone to the dynamics of pro- and anti-inflammatory cytokine in orthopedic surgery perioperative period. Materials and Methods: Thirty patients were studied and randomly into two groups: 15 patients received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and patient-controlled analgesia (PCA) morphine (dexamethasone group) and 15 patients received perioperative analgesia paracetamol and PCA morphine only (control group). Blood samples were taken at the time before anesthesia, immediately postsurgery, 4 h and 24 h after surgery to measure plasma levels of interleukin 6 (IL-6) and IL-10. We recorded the pain intensity and morphine requirement in 4 h and 24 h after surgery. Results: IL-6 levels in the dexamethasone group did not increased from immediately after surgery to 24 h after surgery but increased in the control group ( P P Conclusion: The addition of dexamethasone preoperatively on the combination of paracetamol and morphine did not change plasma levels of IL-6 and IL-10 cytokines Dexamethasone provides sufficient analgesia and decrease postoperative opioid requirement.

The Effect of Dexamethasone on the Dynamics of Inflammation, Cortisol and analgesia in Lower Limb Surgery

Background: Dexamethasone is currently used as a part of multimodal analgesia on postoperative pain management. Dexamethasone considered providing effective analgesia as a steroid anti-inflammatory. This study aimed to examine the effects of preoperative single dose of intravenous dexamethasone to the inflammation, cortisol response and analgesia in lower limb surgery. Methods: This is a clinical experimental study conducted in randomized double-blind trial performed at Wahidin Sudirohusodo Hospital, Makassar Indonesia. Thirty patients with lower limb surgery under spinal anesthesia meet the inclusion criteria were randomly divided into 2 groups: (1) group received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and PCA morphine (dexamethasone group) and (2) group received perioperative analgesia paracetamol and PCA morphine (control group). Blood samples were taken at the time before anesthesia, immediately post-surgery, 4 and 24 hours after surgery to measure plasma levels of CRP and Cortisol with the ELISA test. We recorded the intensity of rest pain and morphine requirement in 4 and 24 hours after surgery. Results: Both of groups found increase in CRP plasma levels at the 24 hours after surgery (p<0.05). Cortisol in the dexamethasone group decreased significantly at the 24 hours after surgery while in the control group did not change (p<0.05). Rest pain intensity and morphine requirement in the dexamethasone group was lower in the 24 hours after surgery than the control group (p<0.05). No differences changes in blood pressure, heart rate, respiration and the side effects between the two groups. Conclusion: The addition of single dose dexamethasone preoperatively on the combination of paracetamol and morphine did not abolish inflammation process but decrease cortisol response after surgery with sufficient analgesia and minimal side effect.

English

OBJECTIVE: Postoperative sore throat and nausea and vomiting are common complaints in patients undergoing surgery, under general endotracheal anesthesia. Some of the studies have shown potential advantages of dexamethasone in prevention of postoperative sore throat. We therefore undertook a study to evaluate the efficacy of dexamethasone 8 mg administration intravenously, in reducing the incidence and severity of postoperative sore throat nausea and vomiting in patients undergoing caesarean section under general anesthesia with endotracheal intubation. METHODS: In a randomized, double blind and placebo controlled study, 60 patients receiving general anesthesia with endotracheal intubation undergoing caesarean section were randomly assigned to two groups. Group-I, patients received dexamethasone 8 mg IV and group-II received normal saline 2 ml IV. After surgery VAS score was used to assess sore throat and nausea, number of episodes of vomiting were recorded by a blinded observer. RESULTS: The overall incidence and severity of postoperative sore throat was less at all times in study group as compared to control group (p 0.05), but severity of vomiting was less in early postoperative period in dexamethasone group (p<0.001). There was significant reduction in incidence and severity of dexamethasone group in delayed postoperative period. CONCLUSION: Single dose dexamethasone reduces the incidence and severity of postoperative sore throat, nausea and vomiting in patients undergoing caesarean section under general endotracheal anesthesia.

Efficacy and Safety of a Single Dose of Dexamethasone Pre Docetaxel Treatment: the Auckland Experience

ABSTRACT Aim: Auckland City Hospital implemented a change to single intravenous (IV) pre-medication (pre-med) 20mg dose of dexamethasone pre-docetaxel treatment, because of patient (pt) reports of un-wanted side effects of insomnia, reflux-oesophagitis, weight gain with multi-dose regimens, and treatment delays to missed oral pre-med doses of dexamethasone. The new pre-med regimen was based on data by Choudham, J Oncol Pharm Practice, 2011. Methods: An audit tool was developed and data were collected prospectively to identify the impact of symptoms and overall safety in pts receiving this regimen. All pts received outpatient treatment at 3 week intervals. 610 cycles of docetaxel were administered to 160 pts with breast, lung, prostate, head & neck cancer who received the following regimens; FEC-D, TC, TH, TCH, Docetaxel, Docetaxel/Carboplatin±trastuzumab, and TPF. Demographics; 126 female and 34 male, median age 53 years (range 28-78). 134 pts commenced treatment with single pre-med dose of dexamethasone (SD). Multi-day (MD) group comprised various IV/PO dexamethasone regimens ranging from day -1 to day 4 (n = 26). The MD group included prostate pts who received IV 20mg dexamethasone plus prednisone 5mg PO BD continuously. Oedema at/before cycle 3 in SD and MD groups were compared. Results: Infusion hypersensitivity reactions (HSR) occurred in 17 cycles (3%) and in 13 patients (8%). 1 pt experienced a severe reaction, leading to treatment discontinuation. Docetaxel was successfully re-administrated after corticosteroids and anti-histamine in all 16 mild/moderate HSR. No HSR occurred after cycle 4. Only 1 pt experienced a weight gain of >10%. Oedema Cycle 3 Nausea & vomiting Cycle 1 Hand/foot syndrome (HFS) Cycle 1 SD 11% 32% 29% MD 12% 35% 11% Conclusions: Single dose dexamethasone is an acceptable first-line pre-med for docetaxel, with the option of adding in additional doses as required. Rates of oedema, N&V and weight gain were comparable to MD regimens. Infusion HSR rate is low and acceptable. Anecdotally it results in less insomnia and reflux-oesophagitis, though a formal comparison would be required to demonstrate this conclusively with validated tools. HFS appears to be more common. Disclosure: All authors have declared no conflicts of interest.

Identifying parental preferences for corticosteroid and inhaled beta-agonist delivery mode in children with acute asthma exacerbations.

This study examines caregiver preferences of single-dose dexamethasone (DEX) versus 5-day oral prednisolone in treating acute asthma exacerbation in a pediatric emergency department (PED). A secondary objective was preference for mode of home inhaled β-agonist administration. Caregivers of patients 2 to 18 years with an acute asthma exacerbation treated in the PED completed a 1-page questionnaire including asthma history and preferences for steroids and β-agonist administration. One hundred caregivers completed the questionnaire. Within the preceding year, 79% had an asthma exacerbation and 73.7% (n = 99) were prescribed prednisolone. DEX was preferred by 79% of caregivers. Preferences were independent of caregiver demographics except in cases of prior intensive care admission, where DEX was less favored (odds ratio = 0.27, P < .046). No difference existed in mode of home β-agonist administration. Most caregivers prefer DEX in acute asthma exacerbation management. No difference exists for home β-agonists. These results may advise clinical practice in pediatric acute asthma exacerbation.

Effects of antenatal dexamethasone and ambroxol on expression of surfactant protein-B mRNA and ;thyroid transcription factor-1 in pulmonary tissue of premature rats

To explore the effects and mechanism of dexamethasone and ambroxol on expression of surfactant protein （SP）-B mRNA and thyroid transcription factor （TTF）-1 in premature rat lung. Methods Sixteen pregnant Sprague-Dawley rats were randomly divided into four equal groups： two doses of dexamethasone （0.2 mg/kg injected intramuscularly on Day 17 and 18 of pregnancy respectively）;single dose of dexamethasone （0.2 mg/kg injected intramuscularly on Day 18 of pregnancy）;ambroxol group （100 mg/kg injected intraperitoneally on Day 16, 17 and 18 of pregnancy respectively）; and control group （normal saline injected intraperitoneally on Day 16, 17 and 18 of pregnancy respectively）. There were four pregnant rats in each group. All of the fetal rats were taken out on Day 19 of pregnancy as the preterm birth model, and 20 fetal rats from each group were randomly selected. The ratio of body weight to fetal lung weight of newborn rats was calculated. Changes in lung morphology were observed under light microscopy and the ratio of alveoli surface area to alveolar septae surface area was calculated. Expression of TTF-1 protein was determined by immunohistochemistry. Expression of SP-B mRNA was detected by reverse transcriptase-polymerase chain reaction. One-way analysis of variance, Student-Newman-Keuls method and Pearson correlation analysis were applied as statistical methods. Results （1） The ratio of body weight to fetal lung weight was （6.5±0.6）, （7.9±0.8）, （9.5±0.8） and （9.5±0.9） mg/g in two doses of dexamethasone group, one dose of dexamethasone group, ambroxol group and control group respectively （F=67.69,P〈0.01）. The ratio of two doses and one dose of dexamethasone group was lower than that of control group （q=17.143 and 9.143, all P〈0.01） and ambroxol group （q=17.143 and 9.143, all P〈0.01）. The ratio of two doses dexamethasone group was lower than that of one dose dexamethasone group （q=8.000, P〈0.01）. （2） The ratio of alveoli surface area to alveolar septae surface area was 2.19±0.15, 1.70±0.18, 1.67±0.13 and 1.08±0.12 in two doses of dexamethasone group, one dose of dexamethasone group, ambroxol group and control group respectively （F=190.85, P〈0.01）. The ratio of two doses of dexamethasone group, one dose of dexamethasone group and ambroxol group were higher than that of the control group （q=33.639, 18.788 and 17.879, all P〈0.01）. The ratio of two doses dexamethasone group was higher than that of one dose dexamethasone group （q=14.848, P〈0.01）. （3） Expression of TTF-1 protein was 0.311±0.018, 0.224±0.019, 0.196±0.013 and 0.191±0.018 in two doses of dexamethasone group, one dose of dexamethasone group, ambroxol group and control group respectively （F=211.69,P〈0.01）. TTF-1 protein expression of two doses and one dose of dexamethasone group were higher than that of control group （q=30.000 and 8.250, all P〈0.01） and ambroxol group （q=28.750 and 7.000, all P〈0.01）. TTF-1 protein expression of two doses dexamethasone group was higher than that of one dose dexamethasone group （q=21.750, P〈0.01）. （4） Expression of SP-B mRNA was 1.25±0.13, 1.15±0.12, 1.10±0.10 and 1.01±0.12 in two doses of dexamethasone group, one dose of dexamethasone group, ambroxol group and control group respectively （F=14.48, P〈0.01）. SP-B mRNA expression of two doses of dexamethasone group, one dose of dexamethasone group and ambroxol group were higher than that of control group （q=9.231, 5.385 and 3.462, all P〈0.01）. SP-B mRNA expression of two doses of dexamethasone group was higher than that of ambroxol group （q=5.769, P〈0.01） and one dose of dexamethasone group （q=3.846, P〈0.01）. （5）TTF-1 expression in two doses of dexamethasone group, one dose of dexamethasone group and control groups was positively correlated with SP-B mRNA expression （r=0.512, 0.597 and 0.449, respectively, all P〈0.05）. Conclusions Ambroxol can accelerate the maturation of fetal lung with minimal adverse effects on fetal lung weight. Ambroxol might be an alternative to dexamethasone to prevent neonatal respiratory distress syndrome. Key words: Dexamethasone; Ambroxol; Pulmonary surfactant-associated protein B; Nuclear proteins; Transcription factors; Infant,premature

A single administration of dexamethasone may protect tibial plateau cartilage in a mechanically stable surgical model of post traumatic osteoarthritis

Purpose: An acute inflammatory phase follows an injury to the knee joint and initiates a cascade of biochemical events that can contribute to degeneration of the cartilage. Cartilage degeneration after injury is central in the development of posttraumatic osteoarthritis (PTOA) – a debilitating disease that is increasingly affecting active younger individuals. It is currently believed that inflammation following intra-articular bleeding from joint injuries could be a cause in the development of PTOA. To study the effects of inflammation alone within the joint, an injury model was developed in which tissue structures responsible for joint function and stability were not directly impacted. Preliminary evidence in this rabbit model of intra-articular bone injury, intended to simulate posttraumatic hemarthrosis, has shown what appears to be an acute inflammatory phase that resolves after surgery and yet still results in the development of significant PTOA. Therefore, we hypothesize that if insult to the joint increases the expression level of acute inflammatory mediators that expose the cartilage to injury then an intervention that inhibits acute inflammation (dexamethasone) will have positive outcomes on cartilage health within this rabbit bone injury model. Dexamethasone (dex) is a glucocorticoid with potent anti-inflammatory properties that has been widely adopted for clinical use (e.g. in the treatment of rheumatoid arthritis, asthma, and various cancers). Methods: Skeletally mature adult female rabbits aged 52 weeks (n = 18) were used in this study. Six animals were not subjected to any interventions and served as un-operated controls. The remaining 12 were all subjected to a femoral notch drill surgery following the guidelines of our institutional animal care facility. Of this group, six rabbits were treated with one intra-articular injection of Dex (0.5 mg/kg) at the time of surgery. As surgical controls, the remaining 6 animals were subjected to drill surgery, but did not receive any dexamethasone treatment. Animals were sacrificed at 9 weeks post surgery. Histological assessment was completed by two blinded observers using a modified Mankin protocol. qPCR was used to analyze the mRNA levels for select anabolic and catabolic molecules, and values were normalized to 18S mRNA. Kruskal-Wallis with Dunn’s multiple comparisons test were used to investigate treatment group differences (significance accepted at p ≤ 0.05). Results: Histological evaluations (Figure 1A) revealed that at 9 weeks post surgery the cartilage on the tibial plateaus of the drill animals was significantly more damaged than that of the un-operated controls and the animals that received the dex treatment after injury. There were no significant differences between the tibial plateau cartilage of the normal and drill + dex treatment groups, suggesting a positive role for dexamethasone. Furthermore, the mRNA analysis (Figure 1B) revealed that even a single dose of dexamethasone at the time of surgery, was sufficient to attenuate the expression of degradative proteinase matrix metalloproteinase 3 (MMP-3), proteoglycans such as versican and biglycan as well as anabolic marker collagen type II (Col-II) in tibial plateau cartilage. Conclusions: Even in the absence of severe biomechanical changes, the cartilage of the tibial plateau is subject to degeneration in this model. This strongly suggests that initial biological changes are sufficient to drive many of the changes observed within the joint. The results of this study suggest that Dexamethasone treatment given at the time of drill surgery had a positive impact in reducing the degradation of the cartilage covering the tibial plateau. Interestingly, treatment with this steroid attenuated the mRNA levels for both anabolic and catabolic molecules.

The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm

Endoscopic submucosal dissection (ESD) is the gold standard technique for en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Little is known about the management of epigastric pain after ESD of gastric neoplasms. This study investigated the utility and safety of single-dose, perioperative, intravenous dexamethasone for epigastric pain relief following ESD. The efficacy of intravenous dexamethasone 0.15 mg/kg (DEXA group) compared with saline-only placebo (placebo) for epigastric pain after ESD of early gastric neoplasms was assessed in a double-blinded, placebo-controlled trial. Patients completed a questionnaire about present pain intensity (PPI) and short-form McGill pain (SF-MP) categories for immediate and 6-, 12-, and 24-h postoperative periods. The primary outcome variable was PPI at 6 h following ESD. Secondary outcome variables included pain medication, SF-MP scores, complications, second-look endoscopic findings, and length of stay. A total of 36 patients participated in the study. The mean 6-h PPI value was lower (p < 0.001) in the DEXA group (1.61 ± 0.21) than in the placebo group (2.66 ± 0.19). The total 6-h SF-MP score, especially the sensory domain, was higher (p = 0.054) in the placebo group (11.56 ± 0.75) than in the DEXA group (8.89 ± 0.75). Tramadol for epigastric pain relief was more frequent (p = 0.026) in the placebo group (44.4%) than in the DEXA group (11.1%). No differences were noted between groups in length of stay or complications, including acute or delayed bleeding. The distribution of artificial ulcer patterns at 48-h post-ESD as determined by second-look endoscopy was similar in both groups. Single-dose perioperative intravenous dexamethasone after ESD effectively relieved epigastric pain 6 h postoperatively.

Excruciating pain and itching occurring at the administration site after intravenous injection of dexamethasone - a prospective clinical study

Dexamethasone is been used preoperatively before many minor surgical procedures.It is believed that single dose of dexamethasone as premedication does not cause any side effect. However during our study conducted on the aftereffect of intravenous administration of dexamethasone an unusual side effect of itching and burning sensationaround abdomen occurred.

The influence of single-dose dexamethasone on masseter and temporal muscles after impacted lower third molar extraction. Pilot study through electromyography evaluation

This study aimed to evaluate the influence ofdexamethasone (Decadron®) administered aspreoperative single dose (8 mg) on the electricalactivity of the masticatory muscles, superficialmasseter and anterior temporal, through electromyographic analysis after lower third molarextraction. Twenty patients who required surgicaltreatment for extraction of these teeth were selected,treated and evaluated. Patients were randomlyassigned to one of the following groups: experimentalgroup that received a single dose of dexamethasone8 mg 1 h before the procedure, or control groupthat underwent extraction without the use ofmedication. Ag/AgCl electrodes were used to recordthe electrical muscle activity before the procedure,after anesthesia, after root section, immediatepostoperative and 7, 15 and 30 days postoperatively.EMG data collected were analyzed by analysis ofvariance and Tukey’s test with a significance level of5% for intra and intergroup comparisons. The resultsshowed no statistically significant differences in thecomparisons within and between groups (p &gt; 0.05).Based on these findings, it can be concluded that thethird molar extraction and the use of dexamethasoneas a preoperative single dose may not interfere in themuscle electrical activity.KeywordsAnti-inflammatory drug; Tooth Avulsion; Dental extraction; Electromyography; Masticatory muscles.

Efeito da dexametasona sobre o leucograma de ovinos sadios

This study described the effects of dexamethasone on the leukogram of sheep. Ten healthy lambs, three to five months old, were used. In the first experiment, a single dose of dexamethasone (0,5 mg/ kg) was applied intramuscularly and blood samples were taken immediately before application, and 24, 48 and 72 hours after. In the second experiment, dexamethasone (0,5 mg/kg) was applied during three consecutive days (on hours 0, 24 and 48). Blood samples were taken immediately before each application and also 72, 96 and 120 hours after the first application. Total and differential white blood cells counts were made. The animals that received a single dose showed neutrophilia but no leukocytosis, and this change was observed only 24 hours after the application. The animals who received three doses showed leukocytosis 24 hours after the first dose and neutrophilia during the first two days. The neutrophil:lymphocyte relationship remained inverted 24 hours after the single dose and up to 48 hours after the third dose. It can be stated that in sheep medicated with dexamethasone the drug effects on leukocyte cynetics become absent 48 hours after the application of a single dose and 72 hours after the last application of consecutives doses during three days.

Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation in adult cardiac surgery?: Table 1:

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation (POAF) in adult cardiac surgery? A total of 70 papers were identified using the search as described below. Of these, eight were identified to provide best evidence to answer the clinical question. These papers consisted of well-designed, double-blinded randomized control trials (RCTs) or meta-analysis of RCTs that presented sufficient data to reach conclusions regarding the issues of interest for this review. Postoperative atrial fibrillation occurrence, outcomes and complications were included in the assessment. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. Literature search showed that the prophylactic use of hydrocortisone (100 mg/day, 4 days) can reduce the incidence of POAF to 30%, compared with 48% in the control group (P = 0.004). One gram of methylprednisolone before surgery followed by 4 mg of dexamethasone every 6 h for 1 day after surgery was also associated with a significant reduction in POAF (21 vs 51%; P = 0.003). Moreover, a single dose of dexamethasone (0.6 mg/kg) can significantly diminish POAF (18.95 vs 32.3%; P = 0.027). The changes in POAF appeared greatest in patients receiving intermediate doses of corticosteroid (50-210 mg of dexamethasone equivalent), while both lower (up to 8 mg) and higher (236-2850 mg) dosing resulted in blunted effects. Similarly, a moderate dose of hydrocortisone (200-1000 mg/day) is as effective as high (1001-10 000 mg/day) and very high doses (10 000 mg/day). Although the optimal dose, dosing interval and duration of therapy are unclear, meta-analysis suggests that a single dose can be as effective as multiple doses. No statistically significant complications associated with the use of corticosteroids were reported in any of the studies. We conclude that a single prophylactic moderate dose of corticosteroid (50-210 mg of dexamethasone equivalent or 200-1000 mg/day hydrocortisone) can significantly reduce the risk of POAF with no significant increase in morbidity or mortality.

Duration of Cortisol Suppression following a Single Dose of Dexamethasone in Healthy Volunteers: A Randomised Double-Blind Placebo-Controlled Trial

The synthetic glucocorticoid dexamethasone is administered to many patients receiving a general anaesthetic to reduce the risk of postoperative nausea and vomiting. Dexamethasone is known to suppress the hypothalamic-pituitary-adrenal axis; however, the duration of this suppression following the standard anti-emetic intravenous dose of 4 to 8 mg used with anaesthesia is unknown. A randomised controlled double-blind crossover trial assessing the effects of 8 mg intravenous dexamethasone versus saline control was performed in ten healthy male volunteers. The adrenal, thyroid and gonadal axes and glucose levels were assessed over a four-day period after dexamethasone administration. All participants had normal baseline hypothalamic-pituitary-adrenal axis function. No difference in cortisol levels was demonstrated at four or eight hours after dexamethasone administration compared with placebo. At 24 hours post dexamethasone, the cortisol had dropped to less than 5% of baseline and returned to normal during the subsequent day. Increased plasma glucose levels were also observed in the dexamethasone group as compared with placebo. A dose of 8 mg of dexamethasone results in significant suppression of the hypothalamic-pituitary-adrenal axis and elevated plasma glucose levels. The cortisol suppression is maximal at approximately 24 hours post dose.